Purpose– The purpose of this paper is to describe conceptions of feasibility of a haptic navigation system for persons with a visual impairment (VI). Design/methodology/approach– Six persons with a VI who were white cane users were tasked with traversing a predetermined route in a corridor environment using the haptic navigation system. To see whether white cane experience translated to using the system, the participants received no prior training. The procedures were video-recorded, and the participants were interviewed about their conceptions of using the system. The interviews were analyzed using content analysis, where inductively generated codes that emerged from the data were clustered together and formulated into categories. Findings– The participants quickly figured out how to use the system, and soon adopted their own usage technique. Despite this, locating objects was difficult. The interviews highlighted the desire to be able to feel at a distance, with several scenarios presented to illustrate current problems. The participants noted that their previous white cane experience helped, but that it nevertheless would take a lot of practice to master using this system. The potential for the device to increase security in unfamiliar environments was mentioned. Practical problems with the prototype were also discussed, notably the lack of auditory feedback. Originality/value– One novel aspect of this field trial is the way it was carried out. Prior training was intentionally not provided, which means that the findings reflect immediate user experiences. The findings confirm the value of being able to perceive things beyond the range of the white cane; at the same time, the participants expressed concerns about that ability. Another key feature is that the prototype should be seen as a navigation aid rather than an obstacle avoidance device, despite the interaction similarities with the white cane. As such, the intent is not to replace the white cane as a primary means of detecting obstacles.

BACKGROUNDWeb-based interventions for pain management are increasingly used with possible benefits, but never used in addition to multimodal rehabilitation (MMR). MMR is recommended treatment for persistent pain in Sweden. The aim was to evaluate the effects of a self-guided, web-based programme added to MMR for work ability, pain, disability and health-related quality of life.METHODSWe included 99 participants with persistent musculoskeletal pain in a randomized study with two intervention arms: (1) MMR and web-based intervention, and (2) MMR. Data was collected at baseline, 4 and 12 months. Outcome measures were work ability, working percentage, average pain intensity, pain-related disability, and health-related quality of life.RESULTSThere were no significant effects of adding the web-based intervention to MMR regarding any of the outcome variables.CONCLUSIONSThis trial provides no support for adding a self-guided, web-based activity programme to MMR for patients with persistent musculoskeletal pain.SIGNIFICANCEThe comprehensive self-guided, web-based programme for activity, Web-BCPA, added to multimodal treatment in primary health care had no effect on work ability, pain, disability or health-related quality of life. Future web-based interventions should be tailored to patients' individual needs and expectations

We evaluated first a self-managed web-based programme for activity compared to waiting list for persons with persistent musculoskeletal pain suited for primary health care. Thereafter, we evaluated the effects and process of a novel multimodal treatment intervention combining the web programme with counselling and physiotherapy.

Design

A weekly comparison of measures of outcome data between those using the self-managed web-based programme to those on a waiting list. After that a Single Subject Experimental Design (SSED) evaluation of the multimodal intervention, structured interviews and log data.

Setting

Clinical setting in primary health care.

Subjects

Ten participants with persistent musculoskeletal pain.

Intervention

First, only a self-managed web-based programme for activity. Thereafter a multimodal intervention combining the web programme with counselling and physiotherapy.

Main measures

Effect measures were work ability, pain intensity, disability and self-efficacy. Process evaluation by interviews of the participants and log data of usage of the modalities.

Results

There were no conclusive effects of the self-managed web-based programme as compared to waiting list. The SSED analyses of the multi-modal showed promising short-term results regarding disability and pain intensity, but no conclusive results for work ability or self-efficacy. The multimodal intervention process seemed successfully implemented, and the importance of physiotherapy and to some extent counselling was emphasized by the participants.

Conclusion

For persons with persistent musculoskeletal pain, the newly designed multimodal intervention in primary care seemed feasible and showed some promising short-terms effects, while the implementation of a self-managed web-based programme as a single intervention seemed without effect.

5. A group learning programme for old people with hip fracture

Elinge, Eva

et al.

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

Löfgren, Britta

Umeå University, Department of Community Medicine and Rehabilitation, Occupational Therapy.

Gagerman, Eva

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

The aim of this study was to examine whether a group learning programme would influence the participants' perceived activity performance and ability to participate in social life after a hip fracture. The study comprised 35 people aged 54-90 years with hip fracture who had completed ordinary care and rehabilitation after their hip fractures. They were randomized to an intervention group (n=21) or to a control group (n=14). The intervention group participated in the group learning programme, while the control group received no intervention. Directly after the intervention and at 12 months after the intervention, no significant change was seen in either group, regarding the ability to perform ADL activities measured by the Barthel ADL index, or the performance of activities that were identified as important to the individual. However, in the intervention group, the number of ADL items perceived to be performed with difficulties decreased, and the perceived ability to participate in social life increased. These changes were not found in the control group. When analysed between groups, however, the only significant difference was the ability to participate in social life after the intervention. Further research is needed to investigate whether an intensive or prolonged period of rehabilitation, at the hospital or in the patient's home, would increase the ability to resume meaningful participation in social life

The aim of this cross-sectional study was to describe the oldest old, with and without previous hip fracture with regard to their ability to perform personal and instrumental activities of daily living (ADL); home adaptations received; possession of assistive devices; perceived health and morale. A random sample drawn from the population of 85-year-olds, all 90-year-olds and all > or =95-year-olds (n =253) in Umea, a city in northern Sweden, were examined. Data obtained from assessments and interviews carried out in the participants' homes, as well as data from medical charts, were analysed. Those with an earlier hip fracture (n = 58) had more difficulties in performing both personal and instrumental ADLs than those without (n = 195) but regarding individual home adaptations and the possession of assistive devices for personal care, no differences were detected between the groups. Self-perceived health and morale were equally good in both groups. The conclusion drawn is that lifelong consequences, in the form of reduced abilities to perform ADLs and wheelchair dependency are common among the oldest old after a hip fracture. Therefore, trials concerning the effects of more extensive and prolonged rehabilitation following hip fracture would be of great interest

Determinants of previous termfunctional balance and mobilitynext term have rarely been investigated in geriatric wards. This study examined if leg muscle previous termstrengthnext term correlates to previous termfunctional balance and mobilitynext term among geriatric inpatients. Fifty inpatients, 29 women and 21 men (mean age 79.6 years) were included. previous termFunctional balancenext term was assessed with the Berg previous termBalancenext term Scale (BBS) and previous termmobilitynext term was assessed with the Physiotherapy Clinical Outcome Variable Scale (COVS). previous termStrengthnext term in the leg extension muscles was measured as 1 Repetition Maximum (1RM) in a leg press and previous termstrengthnext term in the ankle muscles was measured with Medical Research Council grades (MRC, 0–5). The sum scores, and most of the single items, of the BBS and the COVS significantly previous termcorrelatednext term to 1RM/body weight, ankle dorsiflexion, and plantar flexion. In a stepwise multiple regression, ankle dorsiflexion and 1RM/body weight together accounted for 39% of the variance of the BBS and 41% of the variance of the COVS. Estimated values of the BBS and the COVS can be calculated from the equation. In clinical work, the knowledge about how leg muscle previous termstrengthnext term associates with previous termbalance and mobilitynext term may be useful in analyzing underlying causes of reduced previous termbalance and mobilitynext term function, and in planning rehabilitation programs.

The aim of the study was to evaluate a high intensive exercise program in stroke subjects with risk of falls regarding balance, activities of daily life, falls efficacy, number of falls and lifestyle activities. The intervention program contained high intensity functional exercises (HIFE) implemented to real-life situations together with education on falls and security aspects. This was a single-center, single-blinded, randomized controlled trial. Consecutive >55-year-old patients with risk of falls were enrolled and randomized 36 months after first or recurrent stroke to the intervention group (IG, n=15) or to the control group (CG, n=19) who received group discussions about hidden dysfunctions after stroke. Outcomes were Berg Balance Scale (BBS) primarily, Barthel Index (BI), Falls Efficacy Scale International (FES-I) and number of falls secondarily and Frenchay Activities Index last 3 months (FAI-3) tertially. Assessments were done at baseline, post-intervention, 3- and 6-month follow-up by two physiotherapists and one nurse blinded to group allocation. Generalized Estimating Equations with Repeated-measure statistics were used to analyze the data. There were no significant differences between the IG and the CG regarding balance (BBS). BI at 6 months and FES-I post-intervention and 3 months follow-up showed significant improvement in the IG compared with the CG (p<0.05). Number of falls and FAI-3 were without significant change. This study suggests that our program consisting of HIFE implemented in real-life situations together with educational discussions may improve performance of everyday life activities and improve falls efficacy in stroke subjects with risk of falls

Postural control is a complex system. Based on sensorimotor integration, the central nervous system (CNS) maintains balance by sending suitable motor commands to the muscles. Physiological decline due to ageing, affects balance performance through failing postural control – and in turn affects falls self-efficacy and activity participation. Understanding how the CNS adapts to these changes and predicts the appropriate motor commands to stabilize the body, has been a challenge for postural control research the latest years.

Aims

To understand and model the performance of the central nervous system as the controller of the human body.

Methods

Modelling was based on postural control data from 45 older adults (70 years and older). Ankle, knee and hip joint kinematics were measured during quiet stance using a motion capture system. Principal component analysis was used in order to reduce the measured multidimensional kinematics from a set of correlated discrete time series to a set of principal components. The outcome was utilized to predict the motor commands. The adaptive behaviour of the CNS was modelled by recurrent neural network including the efference copy for rapid predictions. The data from joint kinematics and electromyography (EMG) signals of the lower limb muscles were measured and separated into training and test data sets.

Results

The model can predict postural motor commands with very high accuracy regardless of a large physiological variability or balancing strategies. This model has three characteristics: a) presents an adaptive scheme to individual variability, 2) showcases the existence of an efference copy, and 3) is human experimental data driven.

Conclusion

The model can adapt to physical body characteristics and individual differences in balancing behaviour, while successfully predict motor commands. It should therefore be utilised in the continued pursuit of a better understanding of ageing postural control.

15. On Internal Modeling of the Upright Postural Control in Elderly

Jafari, Hedyeh

et al.

Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.

Pauelsen, Mascha

Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.

Röijezon, Ulrik

Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.

Nyberg, Lars

Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.

Nikolakopoulos, George

Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.

Gustafsson, Thomas

Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.

Falls are an increasing problem of aging population, both in home-dwelling and institutionalized people. Automatic fall detection systems are a choice in supporting the independent and secure living of the older people. Typically, health technology applications such as fall detection systems are tested in experimental falls of young adults. However, sensitivity and specificity, and acceptability and usability of these systems in real-life conditions in end users should be the ultimate aim. This paper overviews our set of studies on the technology and algorithms for fall detection, from laboratory-based experiments to long-term real-life field tests. The data obtained during the incremental set of studies suggest that automatic accelerometric fall detection systems might offer a tool for improving safety among older people. Additional studies are needed for further improvement of fall detection sensitivity and decreasing the false alarm rate, and for the implementation of the technology to elderly care ICT platforms.

BACKGROUND: Falls and resulting injuries are particularly common in older people living in residential care facilities, but knowledge about the prevention of falls is limited. OBJECTIVE: To investigate whether a multifactorial intervention program would reduce falls and fall-related injuries. DESIGN: A cluster randomized, controlled, nonblinded trial. SETTING: 9 residential care facilities located in a northern Swedish city. PATIENTS: 439 residents 65 years of age or older. INTERVENTION: An 11-week multidisciplinary program that included both general and resident-specific, tailored strategies. The strategies comprised educating staff, modifying the environment, implementing exercise programs, supplying and repairing aids, reviewing drug regimens, providing free hip protectors, having post-fall problem-solving conferences, and guiding staff. MEASUREMENTS: The primary outcomes were the number of residents sustaining a fall, the number of falls, and the time to occurrence of the first fall. A secondary outcome was the number of injuries resulting from falls. RESULTS: During the 34-week follow-up period, 82 residents (44%) in the intervention program sustained a fall compared with 109 residents (56%) in the control group (risk ratio, 0.78 [95% CI, 0.64 to 0.96]). The adjusted odds ratio was 0.49 (CI, 0.37 to 0.65), and the adjusted incidence rate ratio of falls was 0.60 (CI, 0.50 to 0.73). Each of 3 residents in the intervention group and 12 in the control group had 1 femoral fracture (adjusted odds ratio, 0.23 [CI, 0.06 to 0.94]). Clustering was considered in all regression models. CONCLUSION: An interdisciplinary and multifactorial prevention program targeting residents, staff, and the environment may reduce falls and femoral fractures.

18. Fall and injury prevention in residential care

Jensen, Jane

et al.

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

Nyberg, Lars

Gustafson, Yngve

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

Lundin-Olsson, Lillemor

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

OBJECTIVES: To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition. DESIGN: A preplanned subgroup comparison of the effectiveness of a cluster-randomized, nonblinded, usual-care, controlled trial.SETTING: Nine residential facilities in Umea, Sweden. PARTICIPANTS: All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini-Mental State Examination (MMSE; n = 378).An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean +/- standard deviation = 83.9 +/- 5.8 vs 82.2 +/- 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6-15) vs 17 (13-18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group. INTERVENTION: A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem-solving conferences. MEASUREMENTS: The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group. RESULTS: A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls P =.016 and P =.121 and adjusted hazard ratio P

BACKGROUND AND AIMS: Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling. METHODS: 187 out of all residents living in 9 facilities, > or =65 years of age were at high risk of falling. The facilities were cluster-randomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering. RESULTS: At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (> or =10 cm, p<0.001), but not significantly on the Berg Balance Scale. At 9 months (long-term outcome), 3 intervention and 15 control residents had lost the ability to walk (p=0.001). Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group (p=0.001). Residents with both higher and lower cognition benefited in most outcome measures. Noassociation was found between improved mobility and reduced risk of falling.CONCLUSIONS: Exercise, as part of a fall prevention program, appears to preserve the ability to walk, maintain gait speed, ambulate independently, and improve step height. Benefits were found in residents with both lower and higher cognitive impairment, but were not found to be associated with a reduced risk of falling

AIMS: A prospective study was carried out to investigate the incidence, circumstances, and injuries from falls among frail older people living in three different types of Swedish residential care settings. METHODS: The settings were senior citizens' apartments, an old people's home, and a group dwelling for people with dementia. The falls were registered during the three-year study period on a semi-structured fall report, and injurious falls were categorized according to severity. RESULTS: In total 428 falls occurred among 121 residents. The incidence rate of falls at the group dwelling was twice the rates of the old people's home and senior citizens' apartments (4282 compared with 1709 and 2114 falls per 1000 person-years respectively). Some 27% of the falls occurred during the night (2100h to 0600h) and 28% were related to a visit to the lavatory. The presence of acute disease at the time of a fall was diagnosed in 23% of the falls. Some type of injury occurred in 118 falls (28%) and 36 of these (8%) led to moderate or serious injuries. In total 48 fractures were diagnosed. CONCLUSIONS: In a preventive programme for falls and injuries in residential care settings, areas of particular interest should include falls after mealtimes and falls at night, conditions of acute diseases, rising up from sitting, walking, and activities in progress, especially visits to the lavatory.

OBJECTIVE: To study precipitating factors for falls among older people living in residential care facilities. DESIGN: Prospective cohort study. SETTING: Five residential care facilities. PARTICIPANTS: 140 women and 59 men, mean age +/- SD 82.4 +/- 6.8 (range, 65-97). MEASUREMENTS: After baseline assessments, falls in the population were tracked for 1 year. A physician, a nurse, and a physiotherapist investigated each event, and reached a consensus concerning the most probable precipitating factors for the fall. RESULTS: Previous falls and treatment with antidepressants were found to be the most important predisposing factors for falls. Probable precipitating factors could be determined in 331 (68.7%) of the 482 registered falls. Acute disease or symptoms of disease were judged to be precipitating, alone or in combination in 186 (38.6%) of all falls; delirium was a factor in 48 falls (10.0%), and infection, most often urinary tract infection, was a factor in 38 falls (7.9%). Benzodiazepines or neuroleptics were involved in the majority of the 37 falls (7.7%) precipitated by drugs. External factors, such as material defects and obstacles, precipitated 38 (7.9%) of the falls. Other conditions both related to the individual and the environment, such as misinterpretation (eg, overestimation of capacity or forgetfulness), misuse of a roller walker, or mistakes made by the staff were precipitating factors in 83 (17.2%) of falls. CONCLUSION: Among older people in residential care facilities, acute diseases and side effects of drugs are important precipitating factors for falls. Falls should therefore be regarded as a possible symptom of disease or a drug side effect until proven otherwise. Timely correction of precipitating and predisposing factors will help prevent further falls.

23. Predisposing and precipitating factors for falls among older people in residential care

Kallin, Kristina

et al.

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

Lundin-Olsson, Lillemor

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

Jensen, Jane

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

Nyberg, Lars

Gustafson, Yngve

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures. Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures. We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise.

Falling is a common accident among older people. Automatic fall detectors are one method of improving security. However, in most cases, fall detectors are designed and tested with data from experimental falls in younger people. This study is one of the first to provide fall-related acceleration data obtained from real-life falls. Wireless sensors were used to collect acceleration data during a six-month test period in older people. Data from five events representing forward falls, a sideways fall, a backwards fall, and a fall out of bed were collected and compared with experimental falls performed by middle-aged test subjects. The signals from real-life falls had similar features to those from intentional falls. Real-life forward, sideways and backward falls all showed a pre impact phase and an impact phase that were in keeping with the model that was based on experimental falls. In addition, the fall out of bed had a similar acceleration profile as the experimental falls of the same type. However, there were differences in the parameters that were used for the detection of the fall phases. The beginning of the fall was detected in all of the real-life falls starting from a standing posture, whereas the high pre impact velocity was not. In some real-life falls, multiple impacts suggested protective actions. In conclusion, this study demonstrated similarities between real-life falls of older people and experimental falls of middle-aged subjects. However, some fall characteristics detected from experimental falls were not detectable in acceleration signals from corresponding heterogeneous real-life falls.

Background: About a third of home-dwelling older people fall each year, and institutionalized older people even report a two- or threefold higher rate for falling. Automatic fall detection systems have been developed to support the independent and secure living of the elderly. Even though good fall detection sensitivity and specificity in laboratory settings have been reported, knowledge about the sensitivity and specificity of these systems in real-life conditions is still lacking. Objective: The aim of this study was to evaluate the long-term fall detection sensitivity and false alarm rate of a fall detection prototype in real-life use. Methods: A total of 15,500 h of real-life data from 16 older people, including both fallers and nonfallers, were monitored using an accelerometry-based sensor system with an implemented fall detection algorithm. Results: The fall detection system detected 12 out of 15 real-life falls, having a sensitivity of 80.0%, with a false alarm rate of 0.049 alarms per usage hour with the implemented real-time system. With minor modification of data analysis the false alarm rate was reduced to 0.025 false alarms per hour, equating to 1 false fall alarm per 40 usage hours. Conclusion: These data suggest that automatic accelerometric fall detection systems might offer a tool for improving safety among older people.

About one third of home-dwelling people over 65 years of age fall each year. Falling, and the fear of falling, is one of the major health risks that affects the quality of life among older people, threatening their independent living. In our pilot study, we found that fall detection with a waist-worn triaxial accelerometer is reliable with quite simple detection algorithms. The aim of this study was to validate the data collection of a new fall detector prototype and to define the sensitivity and specificity of different fall detection algorithms with simulated falls from 20 middle-aged (40-65 years old) test subjects. Activities of daily living (ADL) performed by the middle-aged subjects, and also by 21 older people (aged 58-98 years) from a residential care unit, were used as a reference. The results showed that the hardware platform and algorithms used can discriminate various types of falls from ADL with a sensitivity of 97.5% and a specificity of 100%. This suggests that the present concept provides an effective method for automatic fall detection.

Physical restraints are a frequently used but disputed method to prevent falls. The aim of the present study was to investigate how the use of restraints in institutional elder care relates to previous falls and to the estimated fall risk of the individual patient. A total of 1142 patients, mean age 82 years, were included in the study. A questionnaire, the Multi-Dimensional Dementia Assessment Scale (MDDAS), was used to measure motor function, vision, hearing, ADL performance, behavioral symptoms, psychiatric symptoms, cognitive impairment and use of medication. Questions concerning the use of physical restraints and known previous falls were added to the instrument. Based on data from the questionnaire (MDDAS), a score on the Downton Fall Risk Index was calculated for each patient. All in all, 248 (22%) of the patients had been subject to restraints and for 155 of them (14%) such measures had been taken to prevent falls. Only weak connections were found between the restraining of patients to prevent falls and the prevalence of known previous falls during hospital stay (phi = 0.05), and estimated fall risk (phi = 0.07). The results indicate that the use of physical restraints is poorly connected with the estimated fall risk. Therefore, this study may point to a possible overuse of these measures

The aim was to investigate the possibility of increasing lower limb strength, dynamic balance and gait speed in frail older women with residual mobility problems following hip fracture by using a combined and functional training programme with a weighted belt. Three women aged 78-82 participated in this repeated single-subject experimental design study. The intervention phase consisted of a 10-week functional weight-bearing exercise programme performed twice a week. Main outcome measures were assessed twice a week during baseline and intervention phases. Graphic analyses showed substantial improvements in dynamic balance and gait speed, related to the intervention, in all three subjects. During intervention phase, gait speed improved by 16-38% and step test performance (dynamic balance) by 36-67%. The subjects also increased weight load in the belt by 25-80%. No progress was seen regarding isometric knee extension muscle strength, and the control variable, isometric hand-grip strength, remained unchanged. However, dynamic leg strength (one-repetition maximum in leg press, tested before and after intervention) showed substantial increase. Subjects experienced strong improvement and reported no discomfort. In conclusion, functional training with a weighted belt may be suitable for older women to alleviated mobility problems following hip fracture.

31. Perceptions of participating in high-intensity functional exercise among older people dependent in activities of daily living (ADL)

Lindelöf, Nina

et al.

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

Rosendahl, Erik

Gustafsson, Samuel

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.

Nygaars, Joachim

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.

Gustafson, Yngve

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

Nyberg, Lars

Luleå University of Technology, Department of Health Sciences, Health and Rehab.

The purpose of the study was to evaluate how older people, dependent in ADL perceive their participation in a high-intensity, functional exercise program compared to the perceptions of those participating in a control activity. Forty-eight older people living in residential care facilities answered a questionnaire about their perceptions of participating in an activity for three months. They were aged 65-98, had a mean score of 24 on Mini Mental State Examination (MMSE) and 14 on Barthel ADL Index. The participants had been randomized to exercise (n = 20) or control activity (n = 28). Differences in responses between exercise and control activity were evaluated using logistic and ordinal regression analyses. The results show that a majority of the exercise group perceived positive changes in lower limb strength, balance, and in the ability to move more safely and securely compared to a minority of the control group (p < 0.001). Significantly more respondents in the exercise activity answered that they felt less tired due to the activity (p = 0.027) and that they prioritized this activity above other activities (p = 0.010). More exercise participants reported that meeting for three months was too short, and fewer that it was too long compared to the control group (p = 0.038). This study shows that older people living in residential care facilities, dependent in ADL, and with mild or no cognitive impairment had positive perceptions about participating in high-intensity functional exercise. The findings support the use of a high-intensity exercise program in this population of older people

BACKGROUND AND PURPOSE: Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. SUBJECTS: The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68-100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10-29). METHODS: A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. RESULTS: The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. DISCUSSION AND CONCLUSION: The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher.

BACKGROUND AND AIMS: It is of great importance to consider whether a tool's predictive value is generalizable to similar samples in other locations. Numerous fall prediction systems have been developed, but very few are evaluated over a different time period in a different location. The purpose of this study was to validate the predictive accuracy of the Mobility Interaction Fall (MIF) chart, and to compare it to staff judgement of fall risk and history of falls. METHODS: The MIF chart, staff judgement, and fall history were used to classify the risk of falling in 208 residents (mean age 83.2 +/- 6.8 years) living in four residential care facilities in northern Sweden. The MIF chart includes an observation of the ability to walk and simultaneously interact with a person or an object, a vision test, and a concentration rating. Staff rated each resident's risk as high or low and reported the resident's history of falls during the past 6 months. Falls were followed up for 6 months. RESULTS: During the follow-up period, 104 residents (50%) fell at least once indoors. Many of the factors commonly associated with falls did not differ significantly between residents who fell at least once and residents who did not fall. In this validating sample the predictive accuracy of the MIF chart was notably lower than in the developmental sample. A combination of any two of the MIF chart, staff judgement, and history of falls was more accurate than any approach alone; more than half of the residents classified as 'high risk' by two approaches sustained a fall within 3 months. CONCLUSIONS: Residents classified as 'high risk' by any two of the MIF chart, staff judgement, and history of falls should be regarded as particularly prone to falling and in urgent need of preventive measures.

OBJECTIVE: To investigate the effect of a second task on balance and gait maneuvers used in everyday life. Our hypothesis was that those who were more distracted by a familiar manual task performed concurrently with functional maneuvers were more frail and more prone to falls. DESIGN: A cross-sectional design with prospective follow-up for falls. SETTING: Sheltered accommodation in Umea, Sweden. PARTICIPANTS: Forty-two residents (30 women, 12 men; mean age +/- SD = 79.7 +/- 6.1 years), ambulant with or without a walking aid, able to follow simple instructions and able to carry a tumbler. MEASUREMENTS: Timed Up & Go (TUG), i.e., the time taken to rise from an armchair, walk 3 meters, turn round, and sit down again. TUG was repeated with an added manual task (TUGmanual), which was to carry a glass of water while walking. The Montgomery-Asberg Depression Rating Scale, Barthel Index, Functional Reach, Mini-Mental State Examination, and Line Bisection test were used to assess for frailty. The subjects were followed-up prospectively regarding falls indoors for a period of 6-months. RESULTS: Subjects with a time difference (diffTUG) between TUGmanual and TUG of > or = 4.5 seconds were considered to be distracted by the second task. Ten subjects had a difference in time of > or = 4.5 seconds. These subjects were more frail, and seven of them fell indoors during the follow-up period (odds ratio 4.7, 95%Confidence Interval (CI) 1.5-14.2). CONCLUSION: The time difference between the TUGmanual and the TUG appears to be a valid marker of frailty and a useful tool for identifying older persons prone to falling.

35. "Stops walking when talking" as a predictor of falls in elderly people

BACKGROUND AND PURPOSE: The aim of this study was to develop and evaluate a screening tool for the identification of older people living in residential care facilities who are prone to falling. METHOD: Two tests focusing on attentional demands while walking were performed: 'Stops walking when talking' and the 'diffTUG'. Medical assessment, rating for cognition, depression and activities of daily living were also carried out. Falls indoors were followed up prospectively over a period of six months. A flowchart, the Mobility Interaction Fall (MIF) chart, for the identification of older people who are prone to falling was developed. The MIF chart includes an observation of mobility level and 'Stops walking when talking', the diffTUG, a test of vision and a rating of concentration. Study subjects were 78 residents, aged over 65 years, in one residential care facility (22 M; 56 F; median age 82 years, range 66-99 years) in Umea, Sweden. RESULTS: Thirty-three (42%) subjects suffered at least one fall indoors during the follow-up period. The rate of falls differed significantly between those subjects classified as being at risk of falls and those not so classified (log rank test 39.1; p < 0.001; hazard ratio 12.1; 95% CI 4.6-31.8). The positive predictive value for the classification was 78% (95% CI 67-87%) and the negative predictive value was 88% (95% CI 79-95%). CONCLUSION: The initial findings for the MIF chart indicate a promising way of classifying older people at residential care facilities as being at high or low risk of falling. The classification is quick and easy and requires no expensive equipment

BACKGROUND AND AIMS: Delirium is a common postoperative complication in elderly patients which has a serious impact on outcome in terms of morbidity and costs. We examined whether a postoperative multi-factorial intervention program can reduce delirium and improve outcome in patients with femoral neck fractures. METHODS: One hundred and ninety-nine patients, aged 70 years and over (mean age+/-SD, 82+/-6, 74% women), were randomly assigned to postoperative care in a specialized geriatric ward or a conventional orthopedic ward. The intervention consisted of staff education focusing on the assessment, prevention and treatment of delirium and associated complications. The staff worked as a team, applying comprehensive geriatric assessment, management and rehabilitation. Patients were assessed using the Mini Mental State Examination and the Organic Brain Syndrome Scale, and delirium was diagnosed according to DSM-IV criteria. RESULTS: The number of days of postoperative delirium among intervention patients was fewer (5.0+/-7.1 days vs 10.2+/-13.3 days, p=0.009) compared with controls. A lower proportion of intervention patients were delirious postoperatively than controls (56/102, 54.9% vs 73/97, 75.3%, p=0.003). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from fewer complications, such as decubitus ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0+/-17.9 days vs 38.0+/-40.6 days, p=0.028). CONCLUSIONS: Patients with postoperative delirium can be successfully treated, resulting in fewer days of delirium, fewer other complications, and shorter length of hospitalization

A new sample of 116 stroke patients was collected in order to validate a logistic regression model, predicting the chances of severely affected stroke patients being discharged home to independent living. The model was found to be accurate in the new sample, especially for those patients who had a high estimated probability of being discharged home. When the dividing line for the predicted probability for discharge home was set at a value of >/=0.5, the positive and negative predictive values were 74 and 73%, respectively. Further modelling resulted in a new extended model including the variables postural stability on admission, cohabiting, age and perceptual impairment on admission that formed the basis for an index predicting discharge home. This index was then validated in the sample of 93 patients that the first developed model was derived from and showed positive and negative predictive values of 85 and 77%, respectively

BACKGROUND AND PURPOSE: Stroke often has a very negative influence on the victims' perception of their life situation. The aim of this study was therefore to assess the subjects' long-term psychological well-being and to explore associations between subject characteristics, impairments, disabilities, and psychological well-being. METHODS: Of 100 subjects rehabilitated at a specialized geriatric stroke ward after the acute phase, 47 survivors were assessed in their homes 3 years after discharge and interviewed regarding their psychological well-being with the Philadelphia Geriatric Center Morale Scale (PGCMS). RESULTS: Sixty-four percent of the subjects were classified as having high scores for psychological well-being or fell within the middle range. In a cluster analysis, depression was shown to have the strongest association with the subjects' PGCMS scores. Variables including the subjects' social situation and functions as well as age, gender, ability to communicate, and need for help showed a much weaker association with the PGCMS. CONCLUSIONS: More than half of the stroke subjects were classified as having levels of psychological well-being that were good or fairly good. The strong association between PGCMS scores and depression indicates the importance of detecting and treating depression and of following up initiated therapy after stroke.

40. Rehabilitation of stroke patients who are older and severely affected: short- and long-term perspectives

Löfgren, Britta

et al.

Umeå University, Department of Community Medicine and Rehabilitation, Occupational Therapy.

Nyberg, Lars

Gustafson, Yngve

Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.

This review has focused on older and severely affected patients. The following aspects have been studied: the suffering of a stroke, experiences of stroke units, rehabilitation, long-term perspective, and psychological well-being. The conclusion is that older and severely affected patients can make substantial progress during rehabilitation. Most patients can maintain or even improve this progress in the long-term perspective. The review shows that many can stay in independent living with support from home help services and relatives, home adjustments, and assistive devices. In long-term follow-ups, some indications show that stroke patients assess their psychological well-being as good, or fairly good, but detection and treatment of depression are essential

A 3-year follow-up study was performed aimed at describing the outcome for severely affected stroke survivors who had undergone geriatric in-patient rehabilitation. Living conditions, psychological well-being, and changes in functions were assessed in 55 survivors. Twenty-five people were living in the community, 15 in apartment hotels or homes for the aged and 15 in nursing homes. From discharge to follow-up 11 people had had to move to an accommodation offering more support. Living alone, recurrent strokes and functional decline were associated with moving. Many of those living in the community were supported by relatives or home help services. Home adjustments and assistive devices were common and in most cases were aimed at facilitating transfers and bathroom activities. Motor function had deteriorated from discharge to follow-up, otherwise no statistically significant changes were seen in the survivors' abilities and functions. Most survivors had in fact been able to maintain their functions or to make further improvements. Also, their psychological well-being seemed quite good. These results should encourage rehabilitation efforts for elderly people severely affected by stroke

A study aimed at examining the outcome of activities of daily living (ADL) of patients undergoing geriatric stroke rehabilitation was performed. Background and admission data of 99 patients surviving the acute phase and needing further hospital rehabilitation were registered. Forty per cent of the patients improved their ADL ability. The logistic regression modelling with the dichotomous dependent variable improvement versus no improvement showed the following factors associated with improvement: a diagnosis of intracerebral haemorrhage, male sex, high postural stability score at the admission and cohabitation. In conclusion, the most severely affected stroke patients, especially patients with intracerebral haemorrhage, have a great potential for improving their ADL. The results of the logistic regression model can serve as a useful guide when it comes to identifying patients that stand a fair chance of improving during their rehabilitation stay. Equally important, patients with a poor rehabilitation prognosis who may need intensified rehabilitation efforts to achieve optimum improvement can now be identified.

Aim: The aim of this study was to investigate differences in physical capacity between physically active and non-active men and women among graduates from upper secondary school. Subject and methods: Research participants were graduates (38 women and 61 men) from upper secondary school. Physical activity was determined using the International Physical Activity Questionnaire, and participants were dichotomously characterized as being physically active or physically non-active according to the recommendations of the World Health Organization (WHO). Aerobic capacity was measured using the Åstrand cycle ergometer test. Participants also underwent tests of muscular strength and balance. Results: Maximum oxygen uptake differed significantly between physically active and non-active men (mean ± SD 3.6 ± 0.7 vs 3.0 ± 0.6 l/kg, p = 0.002) and women (3.0 ± 0.6 vs 2.5 ± 0.3 l/kg, p = 0.016). There was a difference among physically active and non-active men regarding push-ups (37.1 ± 9.0 vs 28.5 ± 7.0, p < 0.001) and sit-ups (59.2 ± 30.2 vs 39.6 ± 19.4, p = 0.010). No significant differences were found regarding vertical jump or grip strength among men, any of the muscle strength measurements among women, and balance (in any sex). Conclusion: Activity levels had impact on aerobic capacity in both sexes, but did not seem to have the same impact on muscular strength and balance, especially in women

Aim. Physical activity and physical capacity are important health related parameters for all age-groups. Yet, little is known about the relationship between physical activity and physical capacity amongst adolescents about to leave compulsory education. The aim of the study was to investigate how physical capacities are related to self-reported energy expenditure on physical activities at different levels of physical activity and amount of time spent sitting among graduates of upper secondary school. Methods. In total, 99 third grade students participated from upper secondary school. Levels of physical activity and the amount of time spent sitting were assessed using the International Physical Activity Questionnaire (IPAQ). The energy expenditure was calculated based on the activity determined by the IPAQ. The participants’ physical capacity was tested using VO2max, muscle strength and balance measures. The relationship between physical activity and physical capacity was addressed using linear regression models. Results. There was significant relationship between Total METs and aerobic capacity (R2 = 0.15), push-ups (R2 = 0.08) and sit-ups (R2 = 0.07). A stronger significant relationship was revealed for activity performed on Vigorous activity METs for aerobic capacity (R2 = 0.23), push-ups (R2 = 0.18) and sit-ups (R2 = 0.10). The regression analyses for Moderate activity METs, Walking activity METs and time spent Sitting showed no significant relationship to any measures of physical capacity. Conclusion. For adolescents, the intensity of physical activity is of importance for achieving high aerobic capacity, and the amount of time spent sitting does not influence physical capacity.

46. Inactivity in adolescents, what are the effects on physical capacity?

Mikaelsson, Katarina

et al.

Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.

Nyberg, Lars

Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.

Michaelson, Peter

Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. peter.michaelson@ltu.se .

Purpose: The aim of the study was to investigate the effect of physical activity on physical capacity among graduates from upper secondary school.Relevance: Physical activity and physical fitness are important health related parameters, which both have declined the last decades. Adolescents who are about to leave compulsory school and physical education are supposed to peak regarding physical capacity. Therefore it is interesting to investigate the effect physical inactivity (according to WHO-recommendation) have on physical performance.Participants: The participants where third grade students (38 female and 61 male) from upper secondary school (18 - 20 years).Methods: International Physical Activity Questionnaire (IPAQ) was used to estimate the level of physical activity. The participants were divided, in accordance with World Health Organizations recommendations for physical activity, to A) physically inactive or B) physically active. Physical fitness was tested using the Åstrand bicycle test and functional tests of muscular strength and balance.Analysis: By Student's independent t-test, separate for females and males, differences in aerobic capacity, push-ups, grip strength, vertical jump height, sit-ups and balance, between physically inactive and active were tested.Results: Maximum oxygen uptake differed significantly between physically inactive and active males (mean ± SD: 3.0 ± 0.6 l/kg, vs. 3.6 ± 0.7 p = 0.002) and females (2.5± 0.3 l/kg, vs. 3.0 ± 0.6 p = 0.016). There was a difference among physically inactive and active males regarding push-ups (28.5 ± 7.0 vs. 37.1 ± 9.0, p < 0.001) and sit-ups (39.6 ± 19.4 vs. 59.2 ± 30.2, p = 0.010). No significant differences were found regarding vertical jump or grip strength among males, any of the muscle strength measurements among females, and balance (in any sex).Conclusions: The level of physical activity was related to aerobic capacity in both sexes, but did not seem to have the same impact on muscular fitness and balance, especially concerning the females. Since aerobic capacity is an important parameter in preventing future health problems, it is crucial to engage all adolescents in physical activity.Implications: According to this study physical activity have positive effects on aerobic capacity, without similar trend in muscle strength. Addressing strength training, as complement to aerobic training should be recommended regardless of level of physical activity performed. Therefore we see a future need for promoting and designing detailed guidelines regarding strength training for children and adolescents.

47. Is self-rated physical activity a good indicator of physical capacity and is time spent sitting negative for physical capacity?

Mikaelsson, Katarina

et al.

Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.

Nyberg, Lars

Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.

Michaelson, Peter

Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. peter.michaelson@ltu.se .

Purpose: The aim of this study was to relate levels of physical activity to physical capacity and to study whether time sitting influences physical capacity among students in upper secondary school.Relevance: Physical activity and physical fitness are important health related parameters. Modern living habits with increased time spent on sedentary behaviors like watching TV and computer gaming have a potential for a negative influence. This calls for reliable and cost-effective measures of physical activities as indicators of physical capacity as tools for identifying people with an inactive lifestyle.Participants: Research participants where 99 third grade students (38 female, 61 male) from upper secondary school in Sweden (18-20 years).Methods: Levels of physical activity was established using the International Physical Activity Questionnaire (IPAQ) and determined for both 1) Level of activity (Total, Vigorous, Moderate, Walking), 2) IPAQ-classification Amount of activity (High, Medium, Low) and 3) Time sitting. Physical fitness was measured using the Åstrand bicycle test and functional tests of muscular strength.Analysis: The relation between 1) Level of activity, 2) IPAQ- amount of activity and 3) Time sitting and physical capacity was investigated by separate linear regression analyses.Results: There were a relation between Total level of activity and A) aerobic capacity (l/min2) (R2 = 0.1, p = 0.001), B) push-ups (R2 = 0.05, p = 0.011), and C) sit-ups (R2 = 0.046, p = 0.016), while other measure of physical capacity was non significant. An identical pattern was reveled for activity performed on Vigorous level with A) aerobic capacity (l/min2) (R2 = 0.2, p < 0.000), B) push-ups (R2 = 0.16, p < 0.000) and C) sit-ups (R2 = 0.082, p = 0.023). For activity on Moderate level the only significant relation was with aerobic capacity (R2 = 0.033, p = 0.033). For Walking no relation was significant. Regarding the IPAQ-classification of High-, Medium, and Low physical activity, no relation with any measures of physical capacity was found. Further, surprisingly, no relation was found between Time sitting and any measures of physical capacity.Conclusions: The results imply that the intensity of physical activity is of importance for achieving high aerobic capacity, while the amount of activity is not. Further, our results indicate that time sitting is not related to physical capacity.Implications: The self-rated questionnaire IPAQ can be questioned for use as a direct indicator of health parameters as physical capacity. Further, it seems that the intensity of activity is of importance for physical performance.

48. The psychosocial impact on standing devices

Nordström, Birgitta

et al.

Luleå University of Technology, Department of Health Sciences.

Nyberg, Lars

Luleå University of Technology, Department of Health Sciences, Health and Rehab.

Ekenberg, Lilly

County Council of Norrbotten, Department of Research and Development.

Näslund, Annika

Luleå University of Technology, Department of Health Sciences, Health and Rehab.

Purpose: The aim of this study was to explore the psychosocial impact of standing devices as experienced by users. Method: This is the second part of a comprehensive survey in five counties in Sweden where all the subjects with standing devices were invited to participate. The impact of standing devices on functional independence, quality of life and wellbeing was assessed using a questionnaire, Psychosocial Impact of Assistive Devices Scale (PIADS). Results: The psychosocial impact of the standing devices was perceived as positive. The highest PIADS scores in relation to age were found in the oldest group, aged 65 years and older. The ability to walk and independence in ambulation resulted in higher scores than the use of a wheelchair and/or dependence on others. Those who stood often awarded higher scores in the PIADS questionnaire compared to those who used the device less frequently. When standing was integrated in various activities, its psychosocial impact received high scores. Conclusion: The psychosocial impact of standing devices was generally experienced positively. The main results indicated that standing in a standing device had a value and we as professionals should ask the users about the intended purpose of their standing in order to prescribe the optimal device.Implications for Rehabilitation •Standing in standing devices has positive psychosocial impact for the user.•As professionals we should broaden our view of the use of standing devices, i.e. to see the standing device as an aid that not only treats the body’s structures or improves the user’s abilities in activities, but also provides a psychosocial impact on the user’s daily life, and to find meaningful goals for the user from a psychosocial perspective

Purpose: To identify the characteristics of people who use standing devices and to explore their degree of device use, experiences with and reasons for standing, and perceived impact of the use of standing devices on well-being and quality of life (QOL). Method: Anyone with a current prescription at the time for the study in any of five counties in Sweden (n 1/4 545), according to a national register of prescribed devices, was invited to participate in a descriptive survey; the questionnaire was mailed to respondents for self-rating. Results: People between 2 and 86 years old were represented among respondents. Standing time decreased with increased age. Respondents who were totally dependent for mobilization or who had received their standing device more than 5 years earlier used their device most frequently. The most common reasons given for standing were to improve circulation and wellbeing and to reduce stiffness. Conclusion: It is important to pay attention to the experiences of standing for this vulnerable group of people, as the use of a standing device has a positive impact on well-being and QOL.